New Guidelines Back Mammography, Make Breast Self-Exams Optional

Mammograms remain the most important tool for early detection of breast cancer and women no longer are told they should perform breast self-exams beginning in their 20s, according to newly released American Cancer Society guidelines.

The guidelines, which advise doctors and patients on the proper intervals for mammograms and breast exams in an effort to detect breast cancer early, represent the first major change in breast cancer screening recommendations since 1997.

Perhaps the most important recommendation seeks to put to rest the past year's debate among researchers of the value of mammograms, by emphasizing that mammography remains the gold standard for early detection of breast cancer.

“Women and doctors need to understand that we are more confident than ever in the benefits of mammography,” said Debbie Saslow, PhD, director of breast and gynecologic cancers for the American Cancer Society. “The benefit is particularly clear for women in their 40s. We have much more evidence, and much more convincing evidence, that those women benefit.”

For this reason, women are still advised to get a mammogram every year, starting at age 40. And women at high risk for breast cancer should consider annual mammograms at age 30 -- or even younger in some cases -- and adding an ultrasound or MRI exam to their screenings.

The most controversial recommendation seems likely to be the American Cancer Society's change in the guidelines regarding the breast self-exam, which previously was recommended once a month.

The new guidelines recommend that women in their 20s be told about the benefits and limitations of breast self exams, and that it is acceptable for women to choose not to it or do it only occasionally.

The reason for the change, a spokesperson said, is that research has shown that the breast self-exam plays a very small role in detecting breast cancer compared with self awareness, and that the exams did not contribute to breast cancer survival rates.

Where mammograms typically find cancers that have grown for two years, self-exams typically detect cancer that has been growing for six years, Saslow said.

"We don't have evidence that doing it every month is having any survival benefit," she said. "For us it's not a huge change as a lot of people weren't doing breast self-exams anyway. To the public it probably is a big change."

Other Sources: American Cancer Society